Patients complaining of extreme pain

Some patients chronic pain say that their pain is both constant and extreme. A graphic rating scale was used to identify 35 patients in a pain management program who complained of extreme pain. They were compared with 31 subjects who rated their pain as low. The patients with extreme pain were older, were more often female, had a longer history of pain, were disabled longer, had had more surgical procedures and hospitalizations, were more dependent on drugs, had higher ratings of bodily and facial pain behavior, and responded less well to treatment than the patients in the low-pain group. A rating of extreme pain remained a rather fixed presentation. It did not correlate with orthopedic or neurologic diagnoses. Possible explanations of the complaint are discussed, and illustrative case material is presented.